1205866084 NPI number — MS. MAUREEN DIANE GERWITZ LCSWR

Table of content: MS. MAUREEN DIANE GERWITZ LCSWR (NPI 1205866084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205866084 NPI number — MS. MAUREEN DIANE GERWITZ LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERWITZ
Provider First Name:
MAUREEN
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GERWITZ-HIRSCHFELT
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSWR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205866084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 WHEATFIELD ST
Provider Second Line Business Mailing Address:
UNIT 58
Provider Business Mailing Address City Name:
NORTH TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14120-7034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-949-5412
Provider Business Mailing Address Fax Number:
716-535-1053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 WHEATFIELD ST
Provider Second Line Business Practice Location Address:
UNIT 58
Provider Business Practice Location Address City Name:
NORTH TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14120-7034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-949-5412
Provider Business Practice Location Address Fax Number:
716-535-1053
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  035818 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00688211 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02774803 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000528348001 . This is a "BC/BS OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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